If Amazon's steps to disrupt healthcare are making Americans healthier, then the improvement will most likely take place in the business of making prescription drugs more reliable for patients. First, there is much room for improvement. The failure to take prescription drugs kills about 125,000 Americans a year, according to a recent study published in the Annals of Internal Medicine, and this form of noncompliance will cost the health care system $ 100 to $ 289 billion a year
PillPack Online Pharmacy Service, which Amazon.com Inc. bought this week, is already simplifying healthcare for its clients by pre-sorting multiple prescriptions. Amazon could do even more by reducing the 20 to 30 percent of prescriptions that are never supposed to be filled, facilitating communication between physicians and patients, and helping the medical community collect useful data on side effects and customer satisfaction.
Physician and Harvard health care policy professor Anupam Bapu Jena said he was skeptical of Amazon's ability to change the quality of doctor visits or hospital stays, but with prescription drugs, he could imagine a number of big changes, which would benefit the patients
from non-compliance, he said. Some people get filled prescriptions, but not to take them, which is hard for Amazon. But many patients do not fill the prescriptions at all, and here Amazon could take that step away. Drugs would automatically arrive at the patients home.
Jena said there are a number of reasons why people do not take medications. One important factor he sees is that people take medicines to prevent illness or to prevent complications from diabetes, asthma or other diseases. Because these medications often do not make patients feel better in their everyday lives, they are easy to forget or skip. It's not like taking antibiotics or pain medications for a painful infection.
The cost is another factor. He considers this a minor effect. In a study, he said, the researchers divided cardiac patients into two groups, one of which asked for the usual price for a prescription drug, while the other received the drug for free. Free drugs improved compliance, he said, but just a bit, they dropped from about 50 percent to about 55 percent.
But in a broader survey by the Commonwealth Fund, a third of Americans over 65 said they either missed out on going to the doctor if they were ill or could not take the prescriptions because they could not afford the expenses. Since Amazon could act as a big buyer, Jena said, it could be possible that the company negotiated lower drug prices from manufacturers.
My colleague Stephen L. Carter of Bloomberg pointed out this week that access, affordability, or both seem to be contributing to compliance: " Living near a Walmart pharmacy increases the likelihood that someone will taking medication with high blood pressure and reducing preventable hospitalizations by a remarkable 6.2 percent. "
Jena sees even more potential in the world of data. In the future, patients could log in to their Amazon accounts to track their prescribing history and help them better track their own health care. The company could also offer something like the "you might also like" referral engine, but more based on science than browser history. For example, a patient may state that they have coronary heart disease and high cholesterol. Amazon would also have data about the patient's medication and might recommend alternative treatments. Or Amazon could inform doctors that similar patients get a higher dose of the same drug.
Amazon could also collect data on side effects. Clinical trials are not large enough or run for a long enough time to capture the less common side effects. These are usually identified after drugs enter the market and are widespread. However, they could be identified more quickly if patients report side effects, just as they write reviews of products. Not all reported complaints will be attributed to the drugs, but with sufficient data, patterns would emerge.
In the same way, by tracking health outcomes, Amazon could collect much-needed data on dangerous interactions ̵
And finally, Amazon's online pharmacy can ask you about your experience as much as Amazon asks people how they like the disposable diapers or cat food they ordered. People could tell if they had a prescription, and if they did not, they could tick the boxes to indicate the reason – whether it was cost or side effects or forgetfulness, or the perception that the drug was not helping. An Amazon online pharmacy could transfer a lot of strength and responsibility for improving health care to the patients themselves. Which is good, because we are the ones whose life depends on it.
This column does not necessarily reflect the opinion of the editors or the Bloomberg LP and its owners.
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Philip Gray at philipgray @ bloomberg .net